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PubMed2005

Clinical significance of tics and attention-deficit hyperactivity disorder (ADHD) in children with pervasive developmental disorder.

The goal of this study was to examine the clinical significance of co-occurring tics and attention-deficit hyperactivity disorder (ADHD) as indicators of a more complex symptomatology in children with and without pervasive developmental disorder. Parents and teachers completed a Diagnostic and Statistical Manual of Mental Disorders-IV-referenced rating scale for 3- to 5- (n = 182/135) and 6- to 12- (n = 301/191) year-old children with pervasive developmental disorder and clinic controls, respectively. The percentage of children with tic behaviors varied with age: preschoolers (25%, 44%) versus elementary schoolchildren (60%, 66%) (parent and teacher ratings, respectively). For many psychiatric symptoms, screening prevalence rates were highest for the ADHD + tics group and lowest for the group with symptoms of neither, but the pattern of group differences varied by age group and informant. In general, there were few differences between the ADHD only and tics only groups. The pattern of ADHD/tic group differences was similar for both children with and without pervasive developmental disorder. We concluded that these findings support the notion that the co-occurrence of ADHD and tics is an indicator of a more complex psychiatric symptomatology in children with pervasive developmental disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1984

The occurrence of secondary affective disorder in an in-patient population with severe and recurrent affective disorder.

One hundred and eighty nine consecutive in-patients with treatment-resistant affective disorder were administered the Renard Diagnostic Interview to determine whether the 45 with secondary affective disorder (SAD) differed from the 144 with primary affective disorder (PAD). The SAD group, including 15 subjects with bipolar disorder, had an earlier mean age of onset of depression and contained more unmarried individuals. The total secondary group could not usefully be differentiated by assessment of clinical symptoms or discriminating analysis of social and clinical variables. While the present study of a severely depressed population does not lend itself to generalisability, this combined sample does have characteristics of patients used in biological investigations. No significant inter-group discrimination was found to support a previous assumption that identification of a prior psychiatric disorder provides the most suitable mechanism for selecting a population for research in affective disorders.

Adult↗
PubMed2001

Familial psychiatric illness and posttraumatic stress disorder: findings from a family study of substance abuse and anxiety disorders.

BACKGROUND: Aside from the possibility of a direct relationship between individual and familial posttraumatic stress disorder (PTSD), there is accumulating evidence that implicates a family history of psychiatric and substance use disorders as an important risk factor in the development of PTSD and associated symptoms. METHOD: The familial risk of DSM-III-R PTSD was examined within a family study of clinical- and community-ascertained probands (N = 263) and their 1206 adult first-degree relatives. RESULTS: Although PTSD among probands was not found to significantly elevate the risk of PTSD among first-degree relatives, an elevated rate of PTSD was found among the relatives of drug abusing probands compared with the relatives of probands with alcoholism, other anxiety disorders, and normal controls. Additionally, affective disorders were significantly associated with PTSD in relatives (p < .01). When these familial and individual associations were examined according to gender, drug disorders in probands were significantly associated with PTSD only among male relatives (p < .01), while the association between PTSD and comorbid affective disorders was seen primarily among female relatives (p < .01). CONCLUSION: Although probands in the present family study were not selected specifically for PTSD, the data afforded a unique opportunity to examine the profile of familial psychopathology as a part of the complex picture of susceptibility for PTSD. Future family study research will be able to determine the generalizability of the present findings through more complete measurement of diverse forms of trauma.

Adult↗
PubMed2002

Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.

BACKGROUND: The intent of this study was to compare the efficacy and safety of divalproex sodium and placebo in the treatment of women with borderline personality disorder and comorbid bipolar II disorder. METHOD: We conducted a placebo-controlled double-blind study of divalproex sodium in 30 female subjects aged 18 to 40 years who met Revised Diagnostic Interview for Borderlines and DSM-IV criteria for borderline personality disorder and DSM-IV criteria for bipolar II disorder. Subjects were randomly assigned to divalproex sodium or placebo in a 2:1 manner. Treatment duration was 6 months. Primary outcome measures were changes on the interpersonal sensitivity, anger/hostility, and depression scales of the Symptom Checklist 90 (SCL-90) as well as the total score of the modified Overt Aggression Scale (MOAS). RESULTS: Twenty subjects were randomly assigned to divalproex sodium; 10 subjects to placebo. Using a last-observation-carried-forward paradigm and controlling for baseline severity, divalproex sodium proved to be superior to placebo in diminishing interpersonal sensitivity and anger/hostility as measured by the SCL-90 as well as overall aggression as measured by the MOAS. Adverse effects were infrequent. CONCLUSION: The results of this study suggest that divalproex sodium may be a safe and effective agent in the treatment of women with criteria-defined borderline personality disorder and comorbid bipolar II disorder, significantly decreasing their irritability and anger, the tempestuousness of their relationships, and their impulsive aggressiveness.

Adult↗
PubMed1999

Suicide attempts in major affective disorder patients with comorbid substance use disorders.

BACKGROUND: The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. METHOD: Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. RESULTS: The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bipolar disorders, men, and age below 30. CONCLUSION: The tendency for bipolar I, mainly nonmixed patients, to have a relatively high risk of substance abuse and low risk of suicide attempts indicates that mainly depressive or dysphoric (bipolar II, nonbipolar, and bipolar I, mainly mixed) mood disorders may be especially lethal. Differences in risks of substance abuse and suicidal behavior in men and in bipolar I patients further suggest that substance abuse and mood disorders may contribute to suicidal risk with at least partial independence or additivity.

Adult↗
PubMedDate not supplied

Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders.

The aim of this study was to determine some of the demographical and clinical characteristics of conversion disorder in children and adolescents and to ascertain comorbidity with depressive and anxiety disorders. For this purpose 51 children and adolescents (mean age: 13.2 +/- 1.9, range: 9-16 years) who met DSM-IV criteria for conversion disorder were compared with a control group. The subjects of this study were mostly postpubertal girls, and pseudoseizure was the most frequent presentation. Misdiagnoses were frequent among these patients. Eight (15.7%) patients received a comorbid diagnosis of major depression and 19 (37.2%) patients had comorbid anxiety disorders according to DSM-IV diagnostic criteria. Significant differences between the two groups on depression and anxiety scales supported the clinical findings. It was concluded that clinicians should screen every patient with conversion disorder for major depression and anxiety disorders for a better outcome.

Adolescent↗
PubMed2004

[Affective phases in dynamics of personality disorders (on a model of borderline personality disorder)].

Affective phases developing in personality disorder (index-sample--98 patients) were compared to those in cyclothymia (85 patients--control group). A preference of phase dynamics in the group of abnormalities relating to ICD-10 item "Borderline personality disorder" was confirmed. In line with a concept considering personality disorders as clinical syndromes, patients of the index-group have personality disorders with the signs of psychopathological diathesis determined by vulnerability to affective disorders. Affective phases are interpreted not only as an expression of a specific type of personality disorders dynamics but as an emergence of affective pathology, which is alternative to endogenous one both by modus of constitutional predisposition and clinical parameters (egosyntonic moderating of the phase, domination of negative affectivity in its structure, amphitymic duality of pathologically altered affect).

Adolescent↗
PubMedDate not supplied

[Single photon emission computed tomography (SPECT) for the diagnosis of depressive disorders, neurotic and eating disorders].

AIM: The aim of the study was to estimate usefulness of the single photon emission computed tomography (SPECT) for the diagnostics of the depressive disorders, neurotic and eating disorders, and detect the organic factors and correlation between cerebral hypoperfusion and results of Benton's and Bender's tests. MATERIAL AND METHOD: Study of 43 patients (33 women and 10 men) aged 16--59 years (SD+38, 65 +/- 11, 62) which were examined with single photon emission computed tomography (SPECT) and Benton's and Bender's tests during their treatment in the 1st Department of Psychiatry, Medical University in Gdańsk in the years 2000 to 2003. 30 patients were diagnosed with depression (first depressive episodes--8, recurrent depressive disorders--9, organic depression--13), 8--neurotic disorders and 5--eating disorders. RESULTS AND CONCLUSIONS: SPECT in 38 (88,37%) cases showed hypoperfusion mostly on the left side and in the frontal region. Hypoperfusion in the recurrent depressive disorders was considerably greater (nearly significant) in comparison with the first depressive episodes. The correlation between hypoperfusion and CNS impairment examined with Benton's and Bender's tests was observed. The correlation coefficient of was 0.6845.

Adolescent↗
PubMed1994

Epidemiology of psychiatric disorders in Edmonton. Panic disorder.

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS), which gives DSM-III diagnostic data on each individual interviewed. This paper reports results for panic disorder. Panic disorder was found to affect women primarily (female:male morbidity risk 2.2:1). The mean age of onset (first symptom) was 19.3 years for men and 21.5 years for women. Rarely did symptoms first occur after the age of forty. The lifetime prevalence rate was 1.7% for women and 0.8% for men and the lifetime morbidity risk was 3.7% for females and 1.7% for males. All twelve panic symptoms were found to be highly specific for panic disorder. Women complained of more (means = 8.0) symptoms than men (means = 6.0). On average 7.3 symptoms were reported. Those with panic disorder showed increased lifetime prevalence rates for major depressive episode (73.4%), alcohol abuse/dependence (54.2%), drug abuse/dependence (43%) and phobia (44.2%). Altogether, 90.4% of those with panic disorder also met criteria for another DSM-III diagnosis, which was 2.7 times the rate in those who did not have panic disorder.

Adolescent↗
PubMed1997

Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders.

We evaluated the association between attention deficit hyperactivity disorder (ADHD) and the age of onset of psychoactive substance use disorders (PSUD) in adults with ADHD. We hypothesized that ADHD and psychiatric comorbidity would be risk factors for early onset PSUD. We compared 120 referred adults having a clinical diagnosis of childhood-onset ADHD with 268 non-ADHD adults. All diagnoses were obtained using DSM-III-R based structured psychiatric interviews. We used group comparisons of age at onset and Cox proportional hazard models to examine the development of PSUD over time. ADHD was associated with earlier onset of PSUD independently of psychiatric comorbidity. Conduct and juvenile bipolar disorders conferred a significantly increased risk for early onset PSUD independently of ADHD. Psychiatric disorders commonly emerged before the onset of PSUD in both groups. Persistent ADHD with and without psychiatric comorbidity was associated with adolescent onset PSUD. In addition, comorbidity with conduct and juvenile bipolar disorders predicted very early onset PSUD in both ADHD and non-ADHD individuals. These findings confirm and extend previous findings documenting important associations between PSUD and psychiatric comorbidity including persistent ADHD.

Adolescent↗
PubMed2006

Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study.

OBJECTIVE: Self-recognition of eating-disordered behavior was examined in a community sample of young adult women (n = 158) with bulimic eating disorders. METHOD: A vignette was presented describing a fictional person meeting diagnostic criteria for bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described. Scores on measures of eating disorder psychopathology, functional impairment and general psychological distress were compared between participants who recognized a problem with their eating and those who did not. RESULTS: Participants who recognized a problem with their eating (n = 86, 51.9%) had higher levels of eating disorder psychopathology and general psychological distress, were more likely to engage in self-induced vomiting, and tended to be heavier, than those who did not (n = 72, 48.1%). In addition, participants who recognized a problem were more likely to have received treatment for an eating or weight problem. In multivariate analysis, the occurrence of self-induced vomiting and higher body weight were the only variables significantly associated with recognition. CONCLUSION: Poor recognition of eating-disordered behavior may be conducive to low or inappropriate treatment seeking among individuals with bulimic- type eating disorders. The perception that only disorders involving self-induced vomiting are pathological may need to be addressed in prevention programs.

Adult↗
PubMed1999

Continuing education in neurometabolic disorders--serine deficiency disorders.

Serine deficiency disorders comprise a new group of inborn errors of serine metabolism. Patients affected with these disorders present with major neurological symptoms including congenital microcephaly, seizures, psychomotor retardation or polyneuropathy. The diagnosis of serine deficiency is based on the detection of low concentrations of the amino acids serine and glycine in fasted plasma and cerebrospinal fluid (CSF). Amino acid analysis of cerebrospinal fluid is preferable over plasma analysis, because the deficiencies are more pronounced in CSF. Because of the interference of amino acids absorbed from the diet, diagnostic procedures have to be performed in the fasted state. Although the disorders are probably rare and not many cases have been reported, recognition of serine deficiency is important, given the fact that the disorders are potentially treatable. The clinical symptoms respond well to amino acid replacement therapy. So far, three serine deficiency disorders have been reported; 3-phosphoglycerate dehydrogenase deficiency, 3-phosphoserine phosphatase deficiency and a still unexplained serine deficiency disorder. In this paper, we will discuss the various serine deficiency disorders, their biochemical abnormalities and the results of amino acid replacement therapy.

Adolescent↗
PubMed1995

Menstrual disorders in women. Social economic consequences of examining women with menstrual disorders for cancer of the body of the uterus.

OBJECTIVE: To explore the health economic consequences of menstrual disorders in Denmark. DESIGN: Analysis of the total costs of menstrual disorders in women, and a cost effectiveness analysis of menstrual disorders in women. SETTING: The analysis is based on retrospective 1991 data from the Danish National Patient Register, and from 1991 national production figures from the Danish National Health Insurance responsible for the primary health care sector. Furthermore, a survey of the incidence of cancer in Denmark in 1988 has been used. SUBJECTS: In the cost analysis all women who experienced menstrual disorders in 1991 are included, and in the cost effectiveness analysis all women with menstrual disorders who were examined by dilatation and curettage in 1991 were included. MAIN OUTCOME MEASURES: In the cost analysis the outcome measure is the total cost of treating and examining women with menstrual disorders in 1991. In the cost effectiveness analysis the outcome measure is the cost of diagnosing one new case of cancer of the body of the uterus in 1991. RESULTS: Menstrual disorders caused a resource use in the health care sector of 150 mill. DKK in 1991, i.e. approximately 0.4% of the total Danish health expenditure, of which at least 33 mill. DKK were spent on the ca. 25,000 dilatations and curettages which were performed in hospitals and the primary sector. Approximately 600 new cases of cancer of the body of the uterus were diagnosed in Denmark in 1991. The cost of finding one woman with cancer of the body of the uterus was on average 54,500 DKK. The cost variation per new case of cancer of the body of the uterus among different age groups was relatively large. The cost was 1.3 mill DKK per new case if the women were less than 40 years because of a low risk of having cancer of the body of the uterus in this age group. The cost per case was 21,500 DKK in women over 50 years. CONCLUSION: This article raised the question whether too many women under 40 years are examined today by dilatation and curettage when the cost effectiveness of examining the woman is considered.

Adolescent↗
PubMed2002

The Mood Disorder Questionnaire: A Simple, Patient-Rated Screening Instrument for Bipolar Disorder.

Bipolar disorder is frequently encountered in primary care settings, often in the form of poor response to treatment for depression. Although lifetime prevalence of bipolar I disorder is 1%, the prevalence of bipolar spectrum disorders (e.g., bipolar I, bipolar II, and cyclothymia) is much higher, especially among patients with depression. The consequences of misdiagnosis can be devastating. One way to improve recognition of bipolar spectrum disorders is to screen for them. The Mood Disorder Questionnaire is a brief, self-report screening instrument that can be used to identify patients most likely to have bipolar disorder. Once identified, and subsequently appropriately diagnosed, the lives of those with bipolar disorder may be considerably improved.

Journal Article↗
PubMed2005

Managing mood disorders and comorbid personality disorders.

PURPOSE OF REVIEW: To examine the influence of personality disorder comorbidity on the general treatment of mood disorders. RECENT FINDINGS: Personality disorders generally have a negative influence on outcome of mood disorders, both unipolar and bipolar. When the personality features are addressed, however, the outcome is less negative. Recent studies suggest a special role for psychological and educational therapies in the treatment of these comorbid disorders. SUMMARY: The assessment of, and attention to, the management of personality disorder as well as concurrent mood disorder may improve outcome.

Journal Article↗
PubMed1993

Binge eating disorder should be included in DSM-IV: a reply to Fairburn et al.'s "the classification of recurrent overeating: the binge eating disorder proposal".

Extensive recent research supports a proposal that a new eating disorder, binge eating disorder (BED), be included in DSM-IV. BED criteria define a relatively pure group of individuals who are distressed by recurrent binge eating who do not exhibit the compensatory features of bulimia nervosa. This large number of patients currently can only be diagnosed as eating disorder not otherwise specified (EDNOS). Recognizing this new disorder will help stimulate research and clinical programs for these patients. Fairburn et al.'s critique of BED fails to acknowledge the large body of knowledge that indicates that BED represents a distinct and definable subgroup of eating disordered patients and that the diagnosis provides useful information about psychopathology, prognosis, and outcome (Fairburn, Welch, & Hay [in press]. The classification of recurrent overeating: The "binge eating disorder" proposal. International Journal of Eating Disorders.) Against any reasonable standard for adding a new diagnosis to DSM-IV, BED meets the test.

Anorexia Nervosa↗
PubMed2002

A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder.

BACKGROUND: Currently, there is no consensus on the best therapeutic approach to chronic tic disorders and comorbid attention-deficit/hyperactivity disorder (ADHD). To address this issue, we evaluated the tolerability and efficacy of the noradrenergic tricyclic antidepressant desipramine hydrochloride in the treatment of children and adolescents with chronic tic disorders and comorbid ADHD. METHODS: Forty-one children and adolescents with chronic tic disorders, including Tourette disorder and comorbid ADHD, were studied in a 6-week, double-blind, placebo-controlled, parallel trial. Desipramine was titrated weekly up to 3.5 mg/kg per day. We rated ADHD and tic symptoms weekly and monitored adverse effects, laboratory findings, and cardiovascular parameters. RESULTS: Treatment with desipramine (mean total daily dose, 3.4 mg/kg per day) was well tolerated without meaningful adverse effects. Desipramine significantly reduced core symptoms of ADHD (ADHD Rating Scale; 42% decrease from baseline relative to placebo, P<.001), with equal response in inattentive symptoms and hyperactive/impulsive symptoms (P<.001 for both). The ADHD response rate was robust (71% vs 0%; desipramine vs placebo, P<.001). Likewise, desipramine significantly reduced tic symptoms (Yale Global Tic Severity Scale; 30% decrease from baseline relative to placebo, P<.001), with equal response in motor and phonic tic symptoms (P<.01 for both). The tic response rate was substantial (58% vs 5%; desipramine vs placebo, P<.001). There were small but statistically significant differences between desipramine and placebo in heart rate and blood pressure. CONCLUSIONS: Treatment with desipramine was well tolerated and was associated with robust clinically significant reductions in tic and ADHD symptoms in children and adolescents with chronic tic disorders and ADHD diagnoses.

Adolescent↗
PubMed1994

Mood Disorder Service Genetic Database: morbidity risks for mood disorders in 3,942 first-degree relatives of 671 index cases with single depression, recurrent depression, bipolar I, or bipolar II.

There is increasing evidence that genetic factors play a role in the etiology of mood disorders. As a result, relatives of affected individuals are more often asking about their own risks to develop a mood disorder. From 1988 to 1990, all consecutive, unrelated inpatients and outpatients (index cases) presenting to the Mood Disorders Service, Department of Psychiatry, University of British Columbia, had detailed family histories taken, thus creating the Mood Disorders Service Genetic Database. Diagnoses for index cases and their first-degree relatives were made according to Research Diagnostic Criteria and Family History Research Diagnostic Criteria respectively. Morbidity risks for mood disorders were calculated for first-degree relatives (parents, siblings, children--aged 10 and above) of all index cases with a diagnosis of single depression, recurrent depression, bipolar I, or bipolar II disorder. Morbidity risks were calculated using the maximum likelihood approach. Morbidity risk data are presented according to the sex and diagnosis for the index case in an easy reference format for risk counselling. The risks are presented twice, including and excluding data for "high-risk" families whose genetic pedigree is suggestive of "autosomal dominant" inheritance.

Age of Onset↗